PANDAS and PANS
PANDAS and PANS affects 1 in 50 to 1 in 200 children and adults in the United States alone, by a conservative estimate of the PANDAS Network. PANDAS, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, started to become known in the 1990’s when a subgroup of children were identified with a sudden onset of obsessions and compulsions (OCD), vocal or motor tics, and significant behavioral changes. The initial cause was thought to be an active or recent infection with a beta-hemolytic Streptococcus, the bacteria that causes strep throat. There have also been many other auto-inflammatory issues that are thought to cause the onset of PANDAS/PANS including influenza, Lyme disease, rheumatic or scarlet fever, acute glomerulonephritis, and other auto-immune disorders. PANDAS is more common in boys and in children who have not started puberty. There are a multitude of PANDAS criteria and common symptoms to consider:
PANDAS Diagnostic Criteria Includes:
- Sudden onset of obsessions (repetitive thoughts)
- Sudden onset of compulsions (repetitive actions)
- Sudden onset of motor or vocal tics
- Onset typically in the age range of 3 to puberty
- Symptoms are irregular in their course and severity
PANDAS Common Symptoms:
- Restricted eating
- Aggression and rage
- Sensory abnormalities
- Oppositional behaviors
- Increase in separation anxiety
- Symptoms of ADHD
- Mood changes or swings
- Sleep disturbances
- Nighttime bedwetting, daytime urination increase, or both
- Struggles in school such as a change in handwriting or math abilities
Children with PANDAS or PANS related obsessive-compulsive, tic, and behavioral symptoms can benefit from cognitive behavioral therapy (CBT), habit reversal therapy (HRT), and medication management. It should be noted that children with PANDAS and PANS can present as much more sensitive to the side effects of SSRIs and other medications, so it is imperative to work with a medical provider who is experienced with these protocols and to “start low and go slow”. Other treatment options, for more severe cases of PANDAS and PANS, in the current literature, include plasma exchange or immunoglobulin (IVIG) and as always there are a multitude of side effects to consider with these treatments and this should only be considered under the direct care of a qualified medical provider.
With proper treatment, you can learn to support a multi-prong approach including treating symptoms with supportive therapies and working with a team of other specialized medical doctors to remove the inflammatory source and treat immune system dysregulation.
The Anxiety and OCD Treatment Center of Florida successfully treats children and teens symptoms of PANDAS and PANS using the first-line gold standard of treatment for OCD and tics, a specific Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP), Habit Reversal Therapy (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT). Most professionals agree that a combination of CBT with ERP, HRT, and medication is most effective for treating moderate to severe cases. Depending on the individual, other modalities of treatment we use in conjunction with ERP include Acceptance Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT), as well as Medication Management. AOTCF offers a number of PANDAS treatment programs including Individual Therapy, Family or Parent Therapy, Intensive Treatment Therapy, Teletherapy and Home Visits.